Nursing Elites

1. How do the automated data processing systems in the medical C4I headquarters aid in various aspects?

• A. Maintaining patient accountability
• B. Tracking patient movement
• C. Managing health service logistics systems
• D. All of the above

Correct answer: D

Rationale: The automated data processing systems in the medical C4I headquarters play a crucial role in maintaining patient accountability by tracking patient movement and aiding in the management of health service logistics systems. Therefore, the correct answer is D. Option A is incorrect because the systems do more than just maintaining patient accountability. Option B is incorrect as it focuses solely on tracking patient movement, missing the broader scope. Option C is also incorrect as it only addresses the management of health service logistics systems and overlooks the other functionalities provided by the systems.

2. The nurse writes a problem of “potential for complication related to ovarian hyperstimulation” for a client who is taking clomiphene (Clomid), an ovarian stimulant. Which intervention should be included in the plan of care?

• A. Instruct the client to delay intercourse until menses
• B. Schedule the client for frequent pelvic sonograms
• C. Explain that the infusion therapy will take 21 days
• D. Discuss that this may cause an ectopic pregnancy

Correct answer: B

Rationale: Frequent pelvic sonograms help monitor for ovarian hyperstimulation, a serious potential side effect of clomiphene. Instructing the client to delay intercourse until menses (choice A) is not directly related to monitoring or managing ovarian hyperstimulation. Explaining the duration of infusion therapy (choice C) is not relevant to the potential complication of ovarian hyperstimulation. Discussing the risk of ectopic pregnancy (choice D) is important but not the most appropriate intervention for managing ovarian hyperstimulation.

3. People at higher risk for drug-nutrient interactions include:

• A. Infants
• B. People with diabetes
• C. Women of childbearing age
• D. Older men and women

Correct answer: D

Rationale: Older men and women are at a higher risk for drug-nutrient interactions due to factors like polypharmacy, changes in metabolism, and physiological changes associated with aging. Infants are less likely to be exposed to a wide range of medications, reducing their risk. People with diabetes and women of childbearing age may have specific nutrient needs or considerations, but they are not typically at a higher risk for drug-nutrient interactions compared to older adults.

4. A family came to the emergency department with complaints of food poisoning. Which client should the nurse see first?

• A. 32-year-old with diarrhea for 6 hours
• B. 2-year-old with 1 wet diaper in 24 hours
• C. 40-year-old with abdominal cramping
• D. 10-year-old who is nauseated

Correct answer: B

Rationale: In cases of food poisoning, a 2-year-old with reduced urine output is a critical finding indicating dehydration, requiring immediate attention to prevent complications. The reduced urine output is a sign of decreased fluid intake or increased fluid loss, putting the child at high risk for dehydration. This client should be seen first to assess hydration status, initiate necessary interventions, and prevent further complications. While the other symptoms presented by the other clients are concerning, the 2-year-old's decreased urine output poses the most immediate threat to their well-being.

5. The client diagnosed with thalassemia, a hereditary anemia, is to receive a transfusion of packed RBCs. The cross-match reveals the presence of antibodies that cannot be cross-matched. Which precaution should the nurse implement when initiating the transfusion?

• A. Start the transfusion at 10-15 mL per hour for 15-30 minutes
• B. Re-crossmatch the blood until the antibodies are identified
• C. Have the client sign a permit to receive uncrossmatched blood
• D. Have the unlicensed nursing assistant stay with the client

Correct answer: A

Rationale: Starting the transfusion slowly at 10-15 mL per hour for 15-30 minutes is essential when the cross-match reveals the presence of antibodies that cannot be cross-matched. This precaution allows the nurse to monitor for any adverse reactions due to the antibodies. Re-crossmatching the blood until the antibodies are identified (choice B) may delay the transfusion process and put the client at risk. Having the client sign a permit to receive uncrossmatched blood (choice C) is not a standard practice and does not address the immediate need for precautions during transfusion. Having the unlicensed nursing assistant stay with the client (choice D) is unrelated to the safe initiation of the transfusion and is not a precaution specific to managing antibodies in blood products.

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